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NPI Code Detail

MEDICARE: WILLISTON HEALTHCARE AND REHAB, LLC

MEDICARE: WILLISTON HEALTHCARE AND REHAB, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH-754SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NCF-1037OTHERSCDHEC LIC #

General Provider Information

NPI Number : 1750379442
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLISTON HEALTHCARE AND REHAB, LLC
Provider Business Mailing Address
First Line : 5721 SPRINGFIELD RD
Second Line :
City : WILLISTON
State : SC
Zip : 29853-1917
Country : US
Telephone Number : 803-266-3229
Fax Number :
Provider Business Practice Location Address
First Line : 5721 SPRINGFIELD RD
Second Line :
City : WILLISTON
State : SC
Zip : 29853-1917
Country : US
Telephone Number : 803-266-3229
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : HAIM CY PIZAM
Credential :
Telephone Number : 407-454-9096
Provider Enumeration Date : 10/07/2005
Last Update Date : 10/17/2019

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Directions to “WILLISTON HEALTHCARE AND REHAB, LLC ” Practice Location

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